内界膜翻转填塞与内界膜剥除治疗高度近视黄斑裂孔视网膜脱离的Meta分析

A Meta-analysis of the efficacy of internal limiting membrane reversal tamponade and internal limiting membrane stripping for macular hole retinal detachment in the highly myopia eyes

目的:评价玻璃体切除(PPV)联合内界膜(ILM)翻转填塞或ILM剥除在治疗高度近视黄斑裂孔视网膜脱离(MHRD)中解剖学及视力恢复疗效。方法:从中国知网(CNKI)、维普(VIP)、万方数据库(Wan Fang Database)、PubMed、EMbase、The Cochrane Library、Europe PMC、Nature数据库中检索文献,检索时间均为建库至2018-09。以术后6mo为随访时间节点,观察黄斑裂孔闭合、原发性视网膜复位及BCVA情况。采用Review 5.3及Stata 15.1软件进行Meta分析。结果:本研究包括8项研究266眼。ILM翻转填塞在黄斑裂孔闭合率方面优于ILM剥除(RR=2.05,95%CI 1.69～2.49,P<0.00001),在原发性视网膜复位率方面无差异(RR=1.04,95%CI 0.98～1.12,P=0.21),在术后6mo两组BCVA均较术前明显提高(分别为:RR=0.44,95%CI 0.33～0.55,P<0.00001;RR=0.29,95%CI 0.10～0.48,P=0.003),两组间BCVA改善程度的差异结果存在异质性,其结论可能不稳定,尚需更多可靠数据证明。结论:PPV联合ILM翻转填塞在治疗高度近视MHRD患者中更有效。

AIM: To evaluate the anatomical and visual recovery effects of vitrectomy( PPV) combined w ith inner limiting membrane( ILM) reversal tamponade or ILM stripping in the treatment of high myopia macular hole retinal detachment( M HRD). METHODS: The literature was retrieved fromChina Know ledge Netw ork( CNKI),VIP,Wanfang Database,PubM ed, EM base, Cochrane Library, European PM C,and Natural database. The search time w as built until September 2018. The 6-month follow-up time w as used to observe the macular hole closure, primary retinal detachment and BCVA. M eta-analysis w as performed using Review 5.3 and Stata 15.1 softw are. RESULTS: In this study,a comparative analysis of 266 eyes in 8 studies w as included. Statistically,the effect of ILM reversal tamponade in the macular hole closure rate is better than ILM stripping, the difference w as statistically significant( RR = 2.05,95% CI 1.69 to 2.49,P<0. 00001),there w as no statistically significant difference in the efficacy of primary retinal detachment rate( RR =1. 04,95% CI 0.98 to 1.12,P = 0.21),the BCVA of the tw o groups w as significantly higher than that before surgery at6 mo after surgery, the difference w as statistically significant( RR= 0.44,95% CI 0.33 to 0.55,P<0.00001;RR=0.29,95% CI 0. 10 to 0. 48,P = 0. 003). The results of the extent of BCVA improvement betw een the tw o groups are heterogeneous,and the conclusions may be unstable,and more reliable data are needed. CONCLUSION: PPV+ ILM flap insertion is more effective in treating patients w ith high myopia macular hole retinal detachment.